Retrospective follow up of gross motor development in children using propranolol for treatment of infantile haemangioma at Sydney Children's Hospital

Questions have been raised as to whether propranolol, which crosses the blood‐brain barrier, when used early in life may have an adverse effect on gross motor development. A retrospective survey asking questions about gross motor development was sent to the families of children who had been prescribed oral propranolol for infantile haemangioma at Sydney Children's Hospital between 2008 and 2013. It was found that of the 84 patients surveyed, four were delayed in walking unassisted. There was a statistically significant influence if the child was taking other medications which included prednisolone, vincristine, omeprazole, ranitidine, salbutamol, Flixotide, Timoptol and antibiotics. This was not further analysed in this study because of the low numbers involved. There was no statistically significant influence of gestational age, birth weight or length of time on propranolol. This study adds to the retrospective data available; however large‐scale prospective studies are needed to identify unexpected long‐term side‐effects.     

Adverse effects of topical corticosteroids in paediatric eczema: Australasian consensus statement

Atopic eczema is a chronic inflammatory disease affecting about 30% of Australian and New Zealand children. Severe eczema costs over AUD 6000/year per child in direct medical, hospital and treatment costs as well as time off work for caregivers and untold distress for the family unit. In addition, it has a negative impact on a child's sleep, education, development and self‐esteem. The treatment of atopic eczema is complex and multifaceted but a core component of therapy is to manage the inflammation with topical corticosteroids (TCS). Despite this, TCS are often underutilised by many parents due to corticosteroid phobia and unfounded concerns about their adverse effects. This has led to extended and unnecessary exacerbations of eczema for children. Contrary to popular perceptions, (TCS) use in paediatric eczema does not cause atrophy, hypopigmentation, hypertrichosis, osteoporosis, purpura or telangiectasia when used appropriately as per guidelines. In rare cases, prolonged and excessive use of potent TCS has contributed to striae, short‐term hypothalamic‐pituitary‐adrenal axis alteration and ophthalmological disease. TCS use can also exacerbate periorificial rosacea. TCS are very effective treatments for eczema. When they are used to treat active eczema and stopped once the active inflammation has resolved, adverse effects are minimal. TCS should be the cornerstone treatment of atopic eczema in children.     

A prospective study of infantile hemangiomas with a focus on incidence and risk factors

Infantile hemangiomas (IHs) are the most common tumor of infancy and have been estimated to occur in 4% of infants. Only two previous incidence studies of IH in a healthy population have been published, and both of these were performed in the first week of life. The objective was to identify the incidence of IH in an Australian neonatal population and characterize the risk factors. All women who presented to the postnatal ward in a 200-bed maternity hospital were asked to complete a questionnaire. Details of maternal history and birth details were recorded. Two follow-up emails 3 and 6 weeks after discharge were sent to all mothers who consented, asking if their baby had developed an IH. Babies reported to have an IH were seen in clinic to confirm the diagnosis. Details were collected from 1,034 mothers of 1,065 babies; 28 (2.6%) of the infants developed IH. Babies that developed IH were more likely to be female (p < 0.001), have a low birth weight (p = 0.020), be born at a gestational age of <37 weeks (p = 0.005), and be conceived through in vitro fertilization (IVF) (p = 0.001) than those who did not. The incidence of IH at 6 weeks of life was 2.6%.     

Proliferative nodules of undifferentiated spindle cells arising in a large congenital melanocytic naevus

Proliferative nodules (PN) are benign lesions that arise in large congenital melanocytic naevi (LCMN). Clinically and histologically they can be difficult to differentiate from malignancies, which are also associated with LCMN. The PN in this case consisted of undifferentiated spindle cells and exhibited unusual histological features including negative stains for melanocytic markers (S100, HMB45 and MelA), negative stain for c‐Kit, high mitotic index and unusual morphology of the lesional cells. As a result, a firm histological classification could not be made, which posed a challenge for the clinical management.     

Therapeutic embolization of aneurysmal bone cyst

Results of therapeutic embolization of aneurysmal bone cysts in five patients are described. Transcatheter arterial embolization was performed with Ivalon and Gelfoam particles and Gianturco coils. The postembolization period was characterized by complete relief of pain and decrease in size of the aneurysmal bone cyst in all patients. In patients whose follow-up was longer than 12 months, sclerosis and recalcification of bone were present. There were no complications.     

Localised intravascular coagulation complicating venous malformations in children: Associations and therapeutic options

Venous malformations are slow‐flow congenital vascular malformations that enlarge as the child ages and may be associated with localised intravascular coagulation, a consumptive coagulopathy characterised by elevated D‐dimer and decreased fibrinogen levels. The authors review the known correlations between localised intravascular coagulation and venous malformation number, size and planes involved, and call attention to the concept of the progression of localised intravascular coagulopathy as the child ages and their venous malformations enlarge. The authors also discuss the identified therapeutic options for its investigation, management and treatment, including compression garments, anti‐coagulation therapy, sclerotherapy, endovascular laser, surgical excision and sirolimus (rapamycin). Evidence for protocol improvements that may be instigated for the optimal physical and medical therapy of venous malformations complicated by localised intravascular coagulopathy is reviewed.     

Does experience change anything? Attitudes of paramedic students regarding drinking and driving

Purpose

The current study examined attitudes and behavior of first degree emergency medical technician (paramedic) students at Ben-Gurion University of the Negev in Israel toward DUI (driving under the influence).

Methods

Students were asked to complete an anonymous, self-administered, multiple-choice questionnaire and a demographic questionnaire.

Results

We found that 42% of respondents (n = 59) had driven after drinking, and 56% of them had driven after more than one drink in the past year. Furthermore, 70% of the students had been designated drivers in the past year, 31% of whom had drunk-driven. No significant difference was found between past volunteers at MDA* and those who did not volunteer regarding the number of DUI events or the amount of alcohol consumed, but those who did volunteer drank more when engaging in DUI.

Conclusion

Our findings are worrisome and may reveal the strength of social norms for consumption of alcohol on one hand and the lack of suitable education regarding the dangers of alcohol in the health care department on the other hand.